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What is Psychotherapy

What is psychotherapy?
Psychotherapy has been called the ?Talking-Cure?. It is called this precisely because it is in talking that you are able to find relief from internal symptoms. Someone once called this type of talking ?chimney sweeping?: That is to say that as they talk they clear out the all the thoughts in their minds. Psychotherapy is about gaining insight into your thoughts, feelings and behaviors. The therapist helps you gain this insight by listening attentively to your thoughts and offering interpretations that lead you to a place of insight.

Psychotherapy is about working with the ?unconscious?. The unconscious is the thoughts and feelings we have that are out of our immediate awareness, but influence our everyday feelings and behavior. Our unconscious is composed of all the experiences, thoughts and feelings we have had through out our life. This unconscious material is made available as you freely talk about whatever comes to mind in the sessions. This has been called ?Free Association? and is why you should talk about everything that comes to your mind in the sessions, even if they seem irrelevant, ridiculous, crude, or offensive. You should also talk about feelings you have about your therapist and about the therapy process.

Below is a pictorial representation of the human mind as conceived by Sigmund Freud, the father of psychology. As with an iceberg most of our thoughts are below the surface outside of awareness in the place called the unconscious. The preconscious level is those memories that can be called up to the conscious level relatively easily by seeing a picture or by someone bringing up a subject. The unconscious level is repressed memories; thoughts that we have chosen to keep out of our awareness in order to defend ourselves.

It is in accessing this unconscious part of ourselves that we gain the greatest insight about ourselves. That insight is healing and brings about lasting change in our feelings and behaviors.


What psychotherapy is NOT
Psychotherapy is not intellectual learning. Psychotherapy is not about learning new techniques to try to adjust your life, though you will indeed learn new techniques. However techniques without insight will only have short-lived results. Psychotherapy is not a classroom experience where you gain more knowledge; it is rather an internal journey into the self, a place of self-discovery.

Psychotherapy is not advice. The world is full of advice. Part of what brings you to therapy is all the good advice you have received has not worked. It is easy to get lost in the sea of advice that is all around. You don?t really need advice; in fact you probably already know all the good advice. What you need is to find your own voice.

Psychotherapy does not tell you what to do. You will know what to do as you gain insight into yourself. When you become aware of what?s happening to you, inside yourself, and/or between yourself and others you will know better than anyone else what steps you need to take.

Psychotherapy is not motivational encouragement. You will not always ?feel good? about a particular psychotherapy session. In fact sometimes it may become very uncomfortable. The end goal is for you to feel better, but the process can often bring painful feelings. It is important to work through these feelings and not give up because you have a session that does not seem to make you feel happy.

What Should I talk about?
In short you should talk about whatever comes to mind. This may sound simple but it is often very difficult. In our normal conversations we do not say whatever comes to mind; rather we filter everything trying to decide what is appropriate. It is important in psychotherapy to get past this defense and to say whatever thought come to your mind, the good, the bad and the ugly. Your therapist will not judge you or think badly of you in anyway but will rather help you to understand yourself better.

It is good to talk about thoughts and feelings that seem inappropriate. Many thoughts seem inappropriate. They are not the thoughts we use in day-to-day conversation with friends or family. They are often sexual thoughts, violent thoughts, thoughts that are often labeled as ?bad?. It is very important to verbalize these thoughts, because they are your thoughts. It is good to remember that thoughts are not ?bad? or ?good?. They are not actions. They are simply thoughts. It is good to talk about thoughts and feelings about your therapist. You will undoubtedly have thoughts and feelings about your therapist. Sometimes these may be ?good? thoughts and sometimes ?bad? thoughts. It is very important that you talk about these thoughts to your therapist. He/she will not be offended or take them personally but will help you to understand them.

It is good to talk about thoughts about the therapy process. You will have times when you feel therapy is not helping, or it seems you?re getting no where, or you want to quit therapy. You should talk about these thoughts. Again, they come to you for some reason and it will be important and helpful to understand them.

It is good to talk about thoughts about death and dying. Thoughts about dying are not uncommon. Most people, at one time or another, experience thoughts of suicide. Talking about your thoughts of death will not make it happen. Fears of death or wanting to die are important to understand so bring them up to your therapist when they occur.

How long will it take?
How long will it take? As long as it takes?

Length is different for everyone. There is no hard and fast rule for how long therapy will take. Therapy is an active on-going process. Despite the fact that many insurance companies and managed care companies feel that your problems should be resolved in 8 sessions or less, the reality is that this just isn?t the case. Most problems people face have developed over a long time and cannot simply be solved in 8 sessions and anyone who tells you so obviously has not had to deal with any major difficulty in life.

Psychotherapy is not like the rest of the medical world. If you get a cold, you go to the doctor he gives you a diagnosis, lets say The Flu, he prescribes an antibiotic to take 3 times a day and within 10 days you are all better. Some therapists do try to work this way, and your insurance company really wants it to work this way: You come in and see a therapist, he or she gives you a diagnosis, lets say Anxiety Disorder, he/she then gives you some mental exercise to try, you meet him or her 7 more times and you?re all better. The reality is this is baloney. The mind simple does not work like this.

Psychotherapy is a process of insight into unconscious activity that occurs over time. It is best not to think in terms of time, but rather think in terms how you feel and function. That said, below are some typical time frames of what you MAY expect. The session listed are assumed to be meeting least once a week if less than once a week than the time would be extended, if more than once a week than less.

3-4 sessions: This is the time it takes to begin to understand the problems and issues you may be facing. It is also the time in which both the therapist and client decide if they can work together with each other. If there is any reason that either feel that they cannot, then the therapy should end and the client should seek another therapist.

15-20 Sessions: People typically begin to feel some symptom relief with in this time. If your goal is to deal with a current issue or difficulty that has come up this MAY be sufficient to help you function. At this point therapy may end with the understanding that if needed you may return to therapy. This is often the case. Things feel better and issues seem somewhat resolved, however after some time goes by difficulty arises again. If this happens it is good to return to your therapist and continue working.

20+ To work on more complex issues and overall life satisfaction. It takes more time to gain insight and understanding and resolve these issues. Many people remain in therapy for 2 years or more.

Remember if you meet less than once a week results will be slower. If you meet more than once a week you will experience faster gains. So again, it is really more important to judge therapy by how it affects you not how much time it takes.

How often should I come?
With psychotherapy more is always better, however for many reasons it is not always possible so I would say come to therapy as often as you are able.

The minimum amount for effective therapy would be every other week. Some who are preparing to leave therapy or who just need to check in to monitor how medications are working may only come once per month.

Meeting once per week is the most recommended. We live our lives on weekly cycles and that conforms well to our scheduling. If able, meeting twice a week is also highly recommended. It is often hindered by the financial difficulties, but the emotional gains that can be made make it well worth the financial burden. Meeting twice per week allows you to move more quickly to internal issues.

When should I quit?
When you want to. Again there is no hard and fast rule. It is usually helpful to talk to your therapist about quitting therapy over a period of 2-3 sessions. You should never just quit therapy by not showing up.

You may quit therapy when your symptoms have decreased. Many people just want to get through certain life difficulties and when they have accomplished that or are coping adequately they are able to leave therapy. This should be discussed with your therapist and agreed upon by both of you. Below are some warnings about quitting therapy

Beware of the quitting therapy to early. It is common to experience the feeling of wanting to quit therapy; however this may not be the best time to quit. Sometimes therapy is difficult but progress is being made.

Don?t quit therapy when you first start feeling better. Often when a person feels a since of relief they think that the problems is solved and they no longer need therapy. This is like stopping taking antibiotics when you first feel better. The cold usually comes back worse. Beware!! Feelings come and go quickly, and you will experience times of relief, which is great, but this is not the time to quit. Continuing working until both you and your therapist agree that it?s time to move on.

Don?t quit therapy because you get mad at your therapist. It is normal to have all kinds of thoughts and feelings about your therapist. Instead of quitting tell your therapist how you feel and work through the feelings.

Don?t quit therapy because you feel like you stopped making progress. Sometime we get stuck. It is best to work through the stuck feeling rather than quit. Again, talk about these feelings.

Leaving therapy is as important of a decision as beginning therapy and should be done with thoughtfulness and dialogue with your therapist.


What a great post ITL. I really liked the part titled "What Should I Talk About?"...really good stuff :)
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